Recognizing the elbow prosthesis on conventional radiographs

Postoperative outcomes of total elbow replacement in haemophilic elbow arthropathy: A systematic review

INTRODUCTION

Total elbow replacement (TER) is a surgical treatment option for haemophilic elbow arthropathy.

AIM

To review the outcomes of TER in haemophilic elbow arthropathy. The primary outcome measures were perioperative blood loss, postoperative complications, revision rates and length of hospital stay (LOS). Secondary outcomes were elbow range of motion (ROM), functional outcome scores and the visual analogue pain scale (VAS).

MATERIALS AND METHODS

PubMed, Medline, Embase and the Cochrane register were searched conforming to the PRISMA guidelines. Only studies with a minimum postoperative follow-up of 1 year were included. Quality appraisal was performed utilizing the MINORS criteria.

RESULTS

One hundred and thirty-eight articles were identified. Following article screening, only seven studies met the inclusion criteria. A total of 51 TERs in 38 patients were performed, with the Coonrad-Morrey prosthesis utilized in 51% of cases. The pooled postoperative complication and revision rates were 49% and 29%, respectively. Surgery-related postoperative mortality was 3.9%. The mean preoperative Mayo elbow performance score (MEPS) was 43 ± 20 whereas the mean postoperative MEPS was 89 ± 6. Mean preoperative VAS was 7.2 ± 1.9 while the mean postoperative VAS was 2.0 ± 1.4. Mean preoperative and postoperative elbow flexion arcs were 54 ± 15 and 91 ± 10 degrees, respectively. Mean preoperative and postoperative forearm rotation arcs were 86 ± 40 and 135 ± 19 degrees, respectively.

CONCLUSION

TER for haemophilic elbow arthropathy provides good to excellent improvements in pain and elbow ROM postoperatively. However, the overall complication and revision rates are relatively high, when compared to TER performed for other indications.

Short-term outcomes of the Nexel total elbow arthroplasty

BACKGROUND

Third-generation total elbow arthroplasties (TEAs) have shown better mechanical characteristics than older designs. However, these results remain purely mechanical and lack clinical evidence. The purpose of this study was to evaluate clinical and radiographic outcomes of the new-generation semiconstrained Nexel TEA performed at our center.

MATERIALS AND METHODS

Between 2015 and 2017, 9 Nexel TEAs were implanted in 9 patients (mean age 61 years, range 38-71). Indication for further surgery, range of motion, mean Mayo Elbow Performance Score (MEPS), Subjective Elbow Value (SEV), radiolucency lines, outcome measures that included implant survival, complications, and revisions were assessed.

RESULTS

The mean follow-up was 28 months (5-46 months). Average range of motion significantly improved from pre- to postoperation, with flexion from 120° (70°-140°) to 140° (130°-155°) and supination from 60° (0°-80°) to 80° (80°). Average MEPS improved from 33 (5-45) to 85 points (30-95). During the study period, 5 elbows (56%) experienced complications and 2 (22%) underwent revision. Aseptic humeral loosening was the main indication for revision. The survivorship rate without revision was 75% at 45 months.

CONCLUSIONS

The short-term clinical results of the Nexel TEA are satisfactory. However, an unusually high rate of complications and revisions was observed, mainly at the humeral component. Further research with longer follow-up and more patients included are needed to validate this new prosthesis.

Coronoid Impingement Causing Early Failure of Total Elbow Arthroplasty

Total elbow arthroplasty (TEA) is a well-established treatment for end-stage rheumatoid arthritis of the elbow. With improved surgical techniques and implant designs, TEA is also effective in treating elbow osteoarthritis, posttraumatic arthritis, distal humerus nonunion, and comminuted distal humerus fractures in the elderly population. There have been multiple reports of greater than 90% survival rate, free of reoperation at 10 years. We present a case of early failure of TEA caused by coronoid impingement, to provide a surgical pearl for others to avoid this complication.

How Well do Orthopedic Surgeons Recognize Different Models of Total Elbow Arthroplasties on Plain Radiographs with the Use of a Diagnostic Flowchart?

BACKGROUND

Recognition of total elbow arthroplasties (TEAs) on plain radiographs is difficult due to a multitude of different types and models. Especially if surgery reports and documentation are not available, lost or when the primary surgery was performed in another hospital the prosthesis type may be undeterminable. Therefore we investigated in this platform study if a flowchart aids in recognition of thirteen different total elbow arthroplasty models on plain radiographs.

METHODS

An online questionnaire on the Shoulder and Elbow Platform was developed. Plain radiographs of thirteen TEA models were shown with and without the help of an especially developed flowchart describing distinguishing features.

RESULTS

Ten orthopedic surgeons specialized in upper extremity surgery completed the study. Recognition rates of the thirteen total elbow arthroplasty models ranged between 20 and 100 percent without the flowchart. Using the flowchart recognition varied between 40 and 90 percent. The recognition rates with the flowchart were not significantly higher. Inter-observer reliability did not increase on a significant level.

CONCLUSION

Correct recognition of total elbow arthroplasty models with plain radiographs remains imperfect with our developed flowchart. The flowchart increased correct recognition rates and inter-observer reliability.